Switching from Humulin N to Lantus

[Lcrawford]

My vet said he knows nothing about dosing with Lantus, but said give it a shot after I called him to discuss recommendations
From the fdmb. Thinking we should wait until the weekend so we can monitor Yankee closely, but hate to keep him on the Humulin which we know isn't working for him. Help please?

 

[BJM]

I'd start with 0.5 units of Lantus. You're in the process of changing diet, and that can have a significant effect on levels, so starting low is starting safely.

The Lantus forum has a slew of stickie posts on using Lantus that you can print out for the vet, as well as the AAHA guidelines posted in the main forum here.
H
If you want to wait to the weekend to make the switch, can you give the Humulin every 8 hours, with 1/3 of the total dailey dose at each shot?

 

[Blue]

My vet said he knows nothing about dosing with Lantus, but said give it a shot after I called him to discuss recommendations
From the fdmb. Thinking we should wait until the weekend so we can monitor Yankee closely, but hate to keep him on the Humulin which we know isn't working for him. Help please?

You are giving a fair amount of N, so my suggestion would be to pick up a BG meter, lancets and test strips, and start home testing to find out how N is affecting your cat. The Relion meter is quite good and very economical.

At the same time, I'd go to your vet to get the prescription for Lantus and have it on hand... once you know how the N is working, you may want to start Lantus sooner than the weekend.

Lantus can be started low, maybe 1u would be a good start dose since your N dose is high. Lantus will take a few days to fill up the shed so you could start giving Lantus now if you wanted. There are really only 3 tests needed each day as a minimum: before the am shot, before the pm shot, and just before you go to bed.

 

[BJM]

What about starting at 0.5 units on an early evening and testing? It acts slowly and gradually builds up in the body. Initially, he'll probably run a bit high until you get the dose titrated.

Check my signature link Secondary Monitoring Tools for information on urine ketone testing. Ketones develope when fat is broken down for calories because the lack of insulin doesn't let the glucose be used. Ketones are a warning sign of diabetic ketoacidosis which is a potentially fatal complication of diabetes.

After 3-7 days, Lantus stabilizes at a gentle rolling curve every injection/12 hours.

The Lantus Tight Regulation protocol explains how to make dosage adjustments carefully and as soon as 3 days on the same dose if you can get mid-cycle/+6 hr tests on the third day

 

[Lcrawford]

So thankful for the advice! Not sure what I would do w/o the help here.
With our work schedules during the week we are unable to test BG during the day at all, would only be able to do amps and pmps and anything necessary overnight. Maybe if I start at .5 unit of the Lantus at 6:45 Wed evening, testing amps and pmps, and evening testing before bed with more tests Saturday, I could know if I should adjust by Saturday pm? Is that right? And will amps and pmps be enough to warn me if something is going wrong? Does everyone test for keystones then as well? Or only with other indicators?

 

[BJM]

...Maybe if I start at .5 unit of the Lantus at 6:45 Wed evening, testing amps and pmps, and evening testing before bed with more tests Saturday, I could know if I should adjust by Saturday pm? Is that right?

Yup, that could work. Do post in the Lantus forum when you are ready - lots of very experienced folks there. They'll be able to give you better feedback if you've got a spreadsheet set up.

...And will amps and pmps be enough to warn me if something is going wrong? Does everyone test for ketones then as well? Or only with other indicators?

AM/PM is not enough to see if anything is going poorly - some cats may be very low and show no symptoms. Testing for ketones is done when titrating because insufficient insulin provokes fat breakdown, which creates ketones. With a cat that has gone through diabetic ketoacidosis (DKA), you'd test because the cat may be more susceptible to it. A diabetic cat smelling like nail polish remover is another clue towards ketoacidosis that you can detect when it is severe (go to vet asap if you can smell it). (Note: If the breath smells like urine, there may be renal disease.)

The secondary tools, like the 5 Ps, help you track what is normal for your cat, so you have some comparison data for reference. Ex, a hyper kitten suddenly lethargic would be an indicator of a problem.